ECG (peds)
This page is for pediatric patients. For adult patients, see: ECG (main)
Ventricular rate
- Younger/smaller --> higher metabolic rate + lower vagal tone --> faster HR
Axis
- Right axis normal in first 6 months of life
- Blood shunted away from pulm vasculature in utero, higher pulmonary pressures--> relatively thicker RV --> Right axis
- Extreme superior axis
- Axis of -90 - 180 degrees
- Seen with AV canal or atrial septal defects
- AVF lead vector
- Negative QRS vector in AVF seen in some cardiac malformations (e.g. AV septal defects, single ventricle
- Biphasic QRS in AVF can be normal but should be reviewed by peds cards cardiology review. [Evans, 2010]
Intervals
- Age dependant norms
- Smaller muscle mass--> shorter PR
- QTc longer in infants <6mo
T-wave inversions
- T-wave inversions in anterior precordial leads are normal
- T-waves upright in most leads for first 7 days of life
- T-waves typically inverted from 7 days to adolescence
- Once an individual child's T-waves flip upright, they should stay that way (i.e. to become newly inverted again would be pathologic)
Voltage/Ventricular hypertrophy
- Smaller pediatric chest wall --> EKG leads closer to heart --> exagerated voltages
- V2-V5 most likely to appear high voltage
- EKG auto-interpretations may "over-report" left or right ventricular hypertrophy
- LVH (quick/dirty method)
- If R of V6 intersects with baseline of V5--> abnormal
- RVH indicators
- Upright T-wave in V1 after 7 days of life
- If RSR' present; R' taller than R wave
- Pure R wave in V1 in child >6mo
See Also
External Links
- https://pedemmorsels.com/pediatric-ecg/
- https://litfl.com/paediatric-ecg-interpretation-ecg-library/